Robotic enucleations of pancreatic benign or low-grade malignant tumors: preliminary results and comparison with robotic demolitive resections.
Feasibility Studies
Female
Humans
Italy
/ epidemiology
Laparoscopy
/ adverse effects
Male
Middle Aged
Neoplasm Grading
Organ Sparing Treatments
/ adverse effects
Outcome and Process Assessment, Health Care
Pancreas
/ pathology
Pancreatectomy
/ methods
Pancreatic Neoplasms
/ pathology
Postoperative Complications
/ epidemiology
Risk Adjustment
/ methods
Robotic Surgical Procedures
/ adverse effects
Tumor Burden
Benign neoplasms
Demolitive resection
Enucleation
Robotic surgery
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
05
04
2018
accepted:
02
11
2018
pubmed:
14
11
2018
medline:
10
5
2020
entrez:
14
11
2018
Statut:
ppublish
Résumé
The incidental detection of benign to low-grade malignant small pancreatic neoplasms increased in the last decades. The surgical management of these patients is still under debate. The aim of this paper is to evaluate the safety and feasibility of robotic enucleations and to compare the outcomes with non-parenchymal sparing robotic resections. The study included a total of 25 patients. Nine of them underwent a robotic enucleation (EN Group) and 16 patients received a robotic demolitive resection (DR Group). Perioperative and medium-term outcomes were compared between the two groups. Patients' baseline characteristics were similar in the two groups except for presence of symptoms and tumor size, due to the inclusion criteria. Operative time was significantly shorter and postoperative results were better for EN group, including a significant shorter hospitalization (5 vs. 8 days, p = 0.027), reduced pancreatic leaks (22% vs. 50%, p = 0.287) and a better preservation of glandular function (100% vs. 62.5%, p = 0.066). Mortality rate was zero in both groups, with all patients free from disease at a median follow-up of 18 months. The risks of under/overtreatment remain still unavoidable for benign to low-grade malignant small pancreatic neoplasms. Simple enucleation should be performed whenever oncological appropriate, to achieve the best postoperative outcomes. The adoption of robotic technique might widen the indications for parenchymal sparing, minimally invasive surgery.
Sections du résumé
BACKGROUND
The incidental detection of benign to low-grade malignant small pancreatic neoplasms increased in the last decades. The surgical management of these patients is still under debate. The aim of this paper is to evaluate the safety and feasibility of robotic enucleations and to compare the outcomes with non-parenchymal sparing robotic resections.
METHODS
The study included a total of 25 patients. Nine of them underwent a robotic enucleation (EN Group) and 16 patients received a robotic demolitive resection (DR Group). Perioperative and medium-term outcomes were compared between the two groups.
RESULTS
Patients' baseline characteristics were similar in the two groups except for presence of symptoms and tumor size, due to the inclusion criteria. Operative time was significantly shorter and postoperative results were better for EN group, including a significant shorter hospitalization (5 vs. 8 days, p = 0.027), reduced pancreatic leaks (22% vs. 50%, p = 0.287) and a better preservation of glandular function (100% vs. 62.5%, p = 0.066). Mortality rate was zero in both groups, with all patients free from disease at a median follow-up of 18 months.
CONCLUSIONS
The risks of under/overtreatment remain still unavoidable for benign to low-grade malignant small pancreatic neoplasms. Simple enucleation should be performed whenever oncological appropriate, to achieve the best postoperative outcomes. The adoption of robotic technique might widen the indications for parenchymal sparing, minimally invasive surgery.
Identifiants
pubmed: 30421079
doi: 10.1007/s00464-018-6576-3
pii: 10.1007/s00464-018-6576-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2834-2842Références
Pancreatology. 2016 Nov - Dec;16(6):1092-1098
pubmed: 27423534
Int J Med Robot. 2016 Dec;12(4):751-757
pubmed: 26678526
Surgery. 2016 Mar;159(3):901-7
pubmed: 26590096
Br J Surg. 2016 Sep;103(10):1358-64
pubmed: 27480993
Neuroendocrinology. 2016;103(2):153-71
pubmed: 26742109
Surg Laparosc Endosc Percutan Tech. 2016 Feb;26(1):31-7
pubmed: 26766310
Ann Surg Treat Res. 2014 Dec;87(6):285-9
pubmed: 25485235
Arch Surg. 2008 Dec;143(12):1218-21
pubmed: 19075175
Surgery. 2005 Jul;138(1):8-13
pubmed: 16003309
J Gastrointest Surg. 2016 Feb;20(2):277-83
pubmed: 26691146
J Gastrointest Oncol. 2015 Aug;6(4):375-88
pubmed: 26261724
J Gastrointest Surg. 2015 Jan;19(1):117-23; discussion 123
pubmed: 25155459
Surg Clin North Am. 2016 Dec;96(6):1447-1468
pubmed: 27865287
Ann Surg Oncol. 2013 Sep;20(9):2815-21
pubmed: 23771245
Surgery. 2017 Mar;161(3):584-591
pubmed: 28040257
Surgery. 2016 Jan;159(1):302-9
pubmed: 26547726
Ann Surg Oncol. 2016 Apr;23(4):1361-70
pubmed: 26597365
J Gastrointest Surg. 2012 Jul;16(7):1347-53
pubmed: 22528577
Nat Rev Gastroenterol Hepatol. 2012 Feb 07;9(4):199-208
pubmed: 22310917
World J Surg. 2016 Oct;40(10):2497-506
pubmed: 27206401
Endocrinol Metab Clin North Am. 2011 Mar;40(1):1-18, vii
pubmed: 21349409
World J Surg. 2015 Jun;39(6):1557-66
pubmed: 25691214
Langenbecks Arch Surg. 2011 Dec;396(8):1197-203
pubmed: 21553230
Ann Surg Oncol. 2014 Oct;21(11):3515-21
pubmed: 24841347
World J Surg. 2013 Dec;37(12):2761-70
pubmed: 24129799
Surgery. 2016 Jan;159(1):348-9
pubmed: 26531234
Br J Surg. 2014 Jul;101(8):1000-5
pubmed: 24844590
J Endocrinol Invest. 2015 Jun;38(6):605-13
pubmed: 25501604
Br J Surg. 2015 Aug;102(9):1026-36
pubmed: 26041666
BMJ Case Rep. 2013 Feb 05;2013:
pubmed: 23389723
J Gastrointest Surg. 2009 Sep;13(9):1692-8
pubmed: 19548038
Pancreatology. 2012 May-Jun;12(3):183-97
pubmed: 22687371
Ann Surg. 2009 Aug;250(2):187-96
pubmed: 19638912
Ann Surg Oncol. 2015 Aug;22(8):2685-99
pubmed: 25366583
World J Surg. 2016 Dec;40(12):3009-3020
pubmed: 27491323
Ann Surg Oncol. 2010 Jun;17(6):1621-7
pubmed: 20162460
World J Surg. 2016 Mar;40(3):715-28
pubmed: 26608956
Surg Oncol. 2011 Jun;20(2):e84-92
pubmed: 21237638
Surgery. 2016 Apr;159(4):1041-9
pubmed: 26704784
World J Gastrointest Oncol. 2010 Jun 15;2(6):272-81
pubmed: 21160640
Ann Surg. 2013 Oct;258(4):554-9; discussion 559-62
pubmed: 24002300
Br J Surg. 2016 Feb;103(3):226-32
pubmed: 26511392